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Bailly M, Cerchez XL, Bailly F, Berthelot E, Hrynchyshyn N, Goncalves T, Jourdain P. Heart failure in elderly patients: Distinctive features and unresolved issues. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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2
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Hrynchyshyn N, Bailly F, Berthelot E, Briedj A, Urien J, Goncalves T, Jourdain P, Bailly M. Myocardial strain assessment by 2D Speckle Tracking to evaluate the effect of cardiac rehabilitation in patients with or without heart failure. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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3
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Berthelot E, Broussier A, Hittinger L, Belmin J, David J, Genet B, Damy T. Heart failure patients with cardiac amyloidosis are at higher risk of mortality and readmission after acute heart failure: A case control study from ICREX-94. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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4
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Leahova Cerchez X, Berthelot E, Bailly M, Goncalves T, Jourdain P, Paclot M, Mas R. Brain natriuretic peptide interest in very elderly dyspneic patients. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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5
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Gonçalves T, Berthelot E, Cerchez XL, Paclot M, Mas R, Bailly M, Jourdain P. Prognosis in patients over 75 according to acute heart failure or other cause of respiratory failure. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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6
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Bourgeois-Beauvais Q, Lobjois Q, Berthelot E, Signate A, Cabre P. Monozygotic twins with neuro-Behcet syndrome. Rev Neurol (Paris) 2021; 178:400-401. [PMID: 34785044 DOI: 10.1016/j.neurol.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Q Bourgeois-Beauvais
- Service de Neurologie - Centre Hospitalier Universitaire de Martinique, 97200 Fort de France, Martinique.
| | - Q Lobjois
- Service de Neurologie - Centre Hospitalier Universitaire de Martinique, 97200 Fort de France, Martinique
| | - E Berthelot
- Service de Neurologie - Centre Hospitalier Universitaire de Martinique, 97200 Fort de France, Martinique
| | - A Signate
- Service de Neurologie - Centre Hospitalier Universitaire de Martinique, 97200 Fort de France, Martinique
| | - P Cabre
- Service de Neurologie - Centre Hospitalier Universitaire de Martinique, 97200 Fort de France, Martinique
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7
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Logeart D, Berthelot E, Bihry N, Eschalier R, Salvat M, Garcon P, Eicher JC, Cohen A, Tartiere JM, Samadi A, Donal E, deGroote P, Mewton N, Mansencal N, Raphael P, Ghanem N, Seronde MF, Chavelas C, Rosamel Y, Beauvais F, Kevorkian JP, Diallo A, Vicaut E, Isnard R. Early and short-term intensive management after discharge for patients hospitalized with acute heart failure: a randomized study (ECAD-HF). Eur J Heart Fail 2021; 24:219-226. [PMID: 34628697 DOI: 10.1002/ejhf.2357] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/06/2021] [Accepted: 10/04/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Hospitalization for acute heart failure (HF) is followed by a vulnerable time with increased risk of readmission or death, thus requiring particular attention after discharge. In this study, we examined the impact of intensive, early follow-up among patients at high readmission risk at discharge after treatment for acute HF. METHODS AND RESULTS Hospitalized acute HF patients were included with at least one of the following: previous acute HF < 6 months, systolic blood pressure ≤ 110 mmHg, creatininaemia ≥ 180 µmol/L, or B-type natriuretic peptide ≥ 350 pg/mL or N-terminal pro B-type natriuretic peptide ≥ 2200 pg/mL. Patients were randomized to either optimized care and education with serial consultations with HF specialist and dietician during the first 2-3 weeks, or to standard post-discharge care according to guidelines. The primary endpoint was all-cause death or first unplanned hospitalization during 6-month follow-up. Among 482 randomized patients (median age 77 and median left ventricular ejection fraction 35%), 224 were hospitalized or died. In the intensive group, loop diuretics (46%), beta-blockers (49%), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (39%) and mineralocorticoid receptor antagonists (47%) were titrated. No difference was observed between groups for the primary endpoint (hazard ratio 0.97; 95% confidence interval 0.74-1.26), nor for mortality at 6 or 12 months or unplanned HF rehospitalization. Additionally, no difference between groups according to age, previous HF and left ventricular ejection fraction was found. CONCLUSIONS In high-risk HF, intensive follow-up early post-discharge did not improve outcomes. This vulnerable post-discharge time requires further studies to clarify useful transitional care services.
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Affiliation(s)
- Damien Logeart
- Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | | | | | | | | | | | | | - Ariel Cohen
- Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | - Nicolas Mansencal
- Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | - Yann Rosamel
- Hôpital Sud-Francilien, Corbeil-Essonnes, France
| | - Florence Beauvais
- Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Abdourahmane Diallo
- Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Vicaut
- Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Richard Isnard
- Hôpital Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
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8
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Sabouret P, Attias D, Beauvais C, Berthelot E, Bouleti C, Gibault Genty G, Galat A, Hanon O, Hulot JS, Isnard R, Jourdain P, Lamblin N, Lebreton G, Lellouche N, Logeart D, Meune C, Pezel T, Damy T. Diagnosis and management of heart failure from hospital admission to discharge: A practical expert guidance. Ann Cardiol Angeiol (Paris) 2021; 71:41-52. [PMID: 34274113 DOI: 10.1016/j.ancard.2021.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 10/20/2022]
Abstract
Heart failure (HF) has high event rates, mortality, and is challenging to manage in clinical practice. Clinical management is complicated by complex therapeutic strategies in a population with a high prevalence of comorbidity and general frailty. In the last four years, an abundance of research has become available to support multidisciplinary management of heart failure from within the hospital through to discharge and primary care as well as supporting diagnosis and comorbidity management. Within the hospital setting, recent evidence supports sacubitril-valsartan combination in frail, deteriorating or de novo patients with LVEF≤40%. Furthermore, new strategies such as SGLT2 inhibitors and vericiguat provide further benefit for patients with decompensating HF. Studies with tafamidis report major clinical benefits specifically for patients with ATTR cardiac amyloidosis, a remaining underdiagnosed and undertreated disease. New evidence for medical interventions supports his bundle pacing to reduce QRS width and improve haemodynamics as well as ICD defibrillation for non-ischemic cardiomyopathy. The Mitraclip reduces hospitalisations and mortality in patients with symptomatic, secondary mitral regurgitation and ablation reduces mortality and hospitalisations in patients with paroxysmal and persistent atrial fibrillation. In end-stage HF, the 2018 French Heart Allocation policy should improve access to heart transplants for stable, ambulatory patients and, mechanical circulatory support should be considered to avoid deteriorating on the waiting list. In the community, new evidence supports that improving discharge education, treatment and patient support improves outcomes. The authors believe that this review fills the gap between the guidelines and clinical practice and provides practical recommendations to improve HF management.
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Affiliation(s)
- P Sabouret
- Heart Institute, Cardiology department, La Pitié Salpetrière Hospital, Sorbonne University, Paris, France
| | - D Attias
- Cardiology department, Centre Cardiologique du Nord, Saint-Denis, France
| | - C Beauvais
- Cardiology department, La Riboisière Hospital, Inserm UMRS 942, University of Paris, Paris, France
| | - E Berthelot
- Cardiology department, Kremlin Bicêtre Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - C Bouleti
- Cardiology department, Poitiers University Hospital, CIC INSERM 1402, Poitiers, France
| | - G Gibault Genty
- Cardiology department, André Mignot Hospital, Le Chesnay, France
| | - A Galat
- Cardiology department, University Hospital Henri Mondor, UPEC, Créteil, France
| | - O Hanon
- Geriatrics Department, Hospital Broca, Paris Descartes University, Paris, France
| | - J S Hulot
- Pharmacology Department, Georges-Pompidou European Hospital, INSERM, PARCC, CIC1418 Paris-Descartes University, Paris, France
| | - R Isnard
- Heart Institute, Cardiology department, La Pitié Salpetrière Hospital, Sorbonne University, Paris, France
| | - P Jourdain
- Cardiology department, Kremlin Bicêtre Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - N Lamblin
- Cardiology Department, University Hospital, Lille, France
| | - G Lebreton
- Heart Institute, Cardiac Surgery department, La Pitié Salpêtrière Hospital, Sorbonne University, Paris, France
| | - N Lellouche
- Cardiology department, University Hospital Henri Mondor, UPEC, Créteil, France
| | - D Logeart
- Cardiology department, La Riboisière Hospital, Inserm UMRS 942, University of Paris, Paris, France
| | - C Meune
- Department of Cardiology, Avicenne Hospital, Paris 13 University, Bobigny, France
| | - T Pezel
- Cardiology department, La Riboisière Hospital, Inserm UMRS 942, University of Paris, Paris, France
| | - T Damy
- Cardiology department, University Hospital Henri Mondor, UPEC, Créteil, France.
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9
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Berthelot E, Broussier A, Damy T, Donadio C, Cosson S, Rovani X, Salengro E, Billebeau G, Megbemado R, Rekik N, Richard K, Godreuil C, Shourick J, Assayag P, Belmin J, David J, Hittinger L. How a specialized cardiogeratric unit can improve Heart failure management: The ICREX-94 experience. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Raitiere O, Berthelot E, Fauvel C, Guignant P, Si-Belkacem N, Sitbon O, Bauer F. Modeling survival using decision tree analysis in pulmonary hypertension due to left heart disease. the prognostic significance of PVR <3WU when TAPSE <16mm. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
In 2019, PVR<3 WU was adopted to stratify patients at low risk of pulmonary hypertension due to left heart disease (PH-LHD) as well those with isolated PH-LHD. We sought to evaluate whether the supervised machine learning with Decision Tree analysis that provides more information than Cox Proportional analysis by forming a hierarchy of multiple covariates, confirms this risk stratification.
Methods
202 consecutive patients (mean age: 69±11 y, females 42%) with mean pulmonary artery pressure (mPAP)≥20mmHg and wedge pressure>15mmHg were recruited. Transpulmonary pressure gradient ≥12mmHg, pulmonary vascular resistance (PVR) ≥3WU, diastolic pressure gradient ≥7mmHg, pulmonary arterial capacitance<1.1 ml/mmHg, TAPSE<16 mm, peak systolic tissue Doppler velocity<10cm/s and right ventricular end-diastolic area ≥25 cm2 were the seven categorical values to enter the model. To predict the mortality from the Decision Tree, we used the CHAID method. Each node and branch were compared using survival analysis at 6-year follow-up.
Results
Mean PAP, wedge pressure, cardiac index, and PVR were 40.3±10.0mmHg, 22.3±7.1mm Hg, 2.9±0.8L/min/m2, and 3.6±2.1WU, respectively. Among the seven dichotomous values linked to the prognosis in PH-LHD, only 2 variables entered the model. To predict the mortality, TAPSE was first selected following by PVR. Compared to patients with PVR<3WU and TAPSE ≥16mm, patients with PVR ≥3WU and TAPSE ≥16mm or patients with PVR ≥3WU and TAPSE <16 mm has significant increased mortality (HR=3,0, 95% CI: [1,4–6,4], p=0.006 and HR=3,3, 95% CI: [1,6–6,9], p=0.002, respectively), while patients with PVR <3WU and TAPSE <16 mm exhibiting the worst prognosis (HR=7,2, 95% CI: [3,3–15,9], p=0.0001).
Conclusion
Used for solving regression and classification problems, decision tree analysis indicates that among 7 prognostic factors, TAPSE and PVR have to be interpreted altogether and simultaneously in PH-LHD for mortality assessment. Therefore, in future research, PVR <3 WU should be understood primarily based on right ventricular systolic function assessed by echocardiography whether TAPSE is or not ≥16 mm.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- O Raitiere
- University Hospital of Rouen, Cardiology, FHU REMOD VHF, Normandie Univ, UNIROUEN, Rouen, France
| | - E Berthelot
- Hospital Kremlin Bicetre, Cardiology, Paris, France
| | - C Fauvel
- University Hospital of Rouen, Cardiology, FHU REMOD VHF, Normandie Univ, UNIROUEN, Rouen, France
| | - P Guignant
- Les Feugrais Hospital Centre of Elbeuf Intermunicipal Hospital Centre, Cardiology, Elbeuf, France
| | - N Si-Belkacem
- University Hospital of Rouen, Department of Cardiology, Pulmonary Hypertension Referral Center, FHU REMOD-VHF, F76000, Rouen, France
| | - O Sitbon
- Hospital Kremlin Bicetre, Pneumology, Paris, France
| | - F Bauer
- University Hospital of Rouen, Department of Cardiology, Pulmonary Hypertension Referral Center, FHU REMOD-VHF, F76000, Rouen, France
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11
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Bailly MT, Vasile T, Berthelot E, Abdo A, El Hatimi S, Jourdain P, Assayag P. [Saw tooth cardiomyopathy: How to better diagnose?]. Ann Cardiol Angeiol (Paris) 2020; 71:115-117. [PMID: 32782066 DOI: 10.1016/j.ancard.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
With the increasing use of cardiac MRI, several cases were described as "sawtooth cardiomyopathy" or "tiger heart". The pathological aspects of these rare forms of myocardial dysplasia, frequently assimilated to non-compaction of the left ventricle, and its prognostic implications remain unclear. We present a case of "sawtooth cardiomyopathy" in a patient with a transient ischemic attack. This article aims to determine, with the other clinical cases in the literature, the MRI and echocardiography criteria for the diagnosis of this cardiomyopathy. Sawtooth cardiomyopathy is probably under diagnosed and deserves to be better known.
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Affiliation(s)
- M T Bailly
- Service de cardiologie, hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France.
| | - T Vasile
- Service de radiologie, hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | - E Berthelot
- Service de cardiologie, hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | - A Abdo
- Service de radiologie, hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | - S El Hatimi
- Service de cardiologie, hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | - P Jourdain
- Service de cardiologie, hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | - P Assayag
- Service de cardiologie, hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France
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12
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Berthelot E, Mas R, Damy T, Hanon O, Jondeau G, Logeart D, Rouquette A, Assayag P, Jourdain P. NTproBNP and BNP level in acute heart failure patients aged 75 or older are higher than in non-cardiac dyspnoea. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Pham V, Berthelot E, Jourdain P, Tam Bailly M, Motiejunaite J, Robard I, Sitbon O, Bouchachi A, Assayag P. For a better estimation of pulmonary pressures by echocardiography: Need for quality improvement. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Motiejunaite J, Jourdain P, Gellen B, Bailly MT, Bouchachi AA, Humbert M, Rouquette A, Damy T, Chemla D, Assayag P, Berthelot E. P1272 Echocardiographic evaluation of left ventricular filling pressure in patients with heart failure with preserved ejection fraction : usefulness of inferior vena cava measurement. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Context
Echocardiography is an essential tool for evaluation of left ventricular filling pressure (LVFP). We aimed to assess the usefulness of inferior vena cava (IVC) measurement and the 2016 ESC recommendations in patients with suspected heart failure with preserved ejection fraction (HFpEF).
Methods
Invasive hemodynamics and echocardiographic measurements were documented in 132 consecutive patients referred to our centre with dyspnea, left ventricular ejection fraction (LVEF) ≥50%, and suspected pulmonary hypertension on a previous echocardiogram. Echocardiographic measurements of mitral flow (E and A wave velocities), the E/e’ratio, indexed left atrial volume (LAV), tricuspid regurgitation velocity (TRV) and the IVC size and collapsibility were obtained. Increased LVFP was defined by an invasive pulmonary artery wedge pressure (PAWP) > 15 mmHg.
Results
In sinus rhythm patients, the sum of the criteria (E/e’ ratio > 14, TRV > 2.8 m/s and indexed LAV > 34 ml/m²) ≥ 2 had a positive predictive value (PPV) of 63% for PAWP > 15 mmHg, whereas a dilated (> 2.1 cm) and/or non collapsible (≤ 50%) IVC had a PPV of 83%. In atrial fibrillation (AF), a dilated and/or non collapsible IVC had an 86% PPV for increased LVFP. We found that 16% of patients with elevated LVFP were more accurately classified using IVC evaluation than using the current guidelines criteria (net reclassification improvement = 0.25, p <0.05).
Conclusion
Echographic measurements of the IVC size and collapsibility outperformed the classic 2016 recommendations algorithm to evaluate LVFP in sinus rhythm patients with suspected HFpEF. The IVC study was also valuable in patients with atrial fibrillation.
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Affiliation(s)
- J Motiejunaite
- Bicetre University Hospital, Department of Cardiology, Paris, France
| | - P Jourdain
- Bicetre University Hospital, Department of Cardiology, Paris, France
| | - B Gellen
- ELSAN - Polyclinique de Poitiers, Service de cardiologie, Poitiers, France
| | - M T Bailly
- Bicetre University Hospital, Department of Cardiology, Paris, France
| | - A A Bouchachi
- Bicetre University Hospital, Department of Cardiology, Paris, France
| | - M Humbert
- Bicetre University Hospital, Department of Pulmonology, Paris, France
| | - A Rouquette
- Bicetre University Hospital, Service de Santé Publique et Epidémiologie, Kremlin Bicêtre, France
| | - T Damy
- University Hospital Henri Mondor, Department of Cardiology; heart failure and amyloidosis unit, Creteil, France
| | - D Chemla
- Bicetre University Hospital, Department of Cardiology, Paris, France
| | - P Assayag
- Bicetre University Hospital, Department of Cardiology, Paris, France
| | - E Berthelot
- Bicetre University Hospital, Department of Cardiology, Paris, France
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15
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Broussier A, Berthelot E, Kharoubi M, Barnabas G, Bonnefous L, Beauvais F, Pezel T, Bauer F, Raitiere O, Taieb C, Benedyga V, Bastuji Garin S, David JP, Audureau E, Damy T. P6321Therapeutic optimization and inclusion in rehabilitation and education programs depend on age in chronic heart failure. A report of the French survey OFICSel. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart Failure (HF) is a major public health problem resulting in high rates of hospitalization and mortality. Frequency of HF increase due to the aging of population and improvement of treatments. Therefore, we hypothetized that elderly is a factor that might limit access to appropriate HF Care.
Purpose and methods
Our aim was to analyzed the optimization therapy and participation in rehabilitation and education programs depending according to classes of age (<40 years, 40–50; 50–60; 60–70; 70–80 and >80) in a large French HF population (out and in-patients, de novo/chronique/acute; consultation/hospitalization/rehabilitation; all LVEF classes and any type of cardiologist practice). Data were analized according to age groups
Results
A total of 2729 HF patients from 79 French departments were included of whom 36% were out patients, 53% were in-patients and 11% were in rehabilitation center. 16% were de novo Chronic HF and 31% were in Acute HF. Elderly patients were more frequently included in acute HF. Main data according on classes of age are presented in the table. Ischemic etiology and valvular diseases increased with age (p<0.0001). Cardiovascular risk factors (HTA, hypercholesterolemia) and atrial fibrillation were more frequent with ageing (p<0.0001).
Beta-blockers, angiotensin converting enzyme inhibitors, and anti-aldosterone, were less prescribed after 60 years old (p<0.0001) as therapeutic education or rehabilitation programs (p<0.0001). Modern means of communication (e-mail, smartphone and internet) were less used by elderly patients.(p<0.0001).
Main data according on classes of age Characteristics All (n=2729) <40 (n=91) 40–50 (n=197) 50–60 (n=447) 60–70 (n=706) 70–80 (n=715) >80 (n=573) p SBP 120±21 107±15 117±21 117±21 118±21 122±20 126±22 <0.0001 NYHA Class <0.0001 I 339 (13.8) 16 (19.3) 42 (23.5) 87 (21.4) 103 (16.1) 57 (8.8) 34 (6.7) II 1187 (48.2) 45 (54.2) 95 (53.1) 213 (52.3) 311 (48.5) 314 (48.4) 209 (41.3) III 763 (31.0) 20 (24.1) 34 (19.0) 97 (23.8) 199 (31.0) 206 (31.7) 207 (40.9) IV 176 (7.1) 2 (2.4) 8 (4.5) 10 (2.5) 28 (4.4) 72 (11.1) 56 (11.1) LVEF 36 (29–50) 33 (26–44) 35 (25–45) 35 (25–42) 35 (25–45) 40 (30–50) 44 (32–55) <0.0001 NTproBNP 1808 (690–4323) 1176 (569–2434) 737 (294–1945) 1072 (346–2611) 1480 (619–3597) 2287 (1015–5689) 3275 (1500–6240) <0.0001 Plus-minus values are means ± SD, n (%) median (IQR).
Origin of patients according on classes
Conclusion
Elderly patients receive less Chronic HF treatment, and are less included in patient education and rehabilitation program despite having more comorbidities and cardiovascular risk factors. Thus, to improve outcome, the health care system needs to be adapt to the patients'age.
Acknowledgement/Funding
SFC, CNCF, CNCH, FFC, Alliance du coeur, GERS, SNSMCV
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Affiliation(s)
- A Broussier
- Henri Mondor/Emile Roux University Hospital, Geriatric, Creteil, France
| | - E Berthelot
- Bicetre University Hospital, Cardiology, Le Kremlin-Bicetre, France
| | - M Kharoubi
- University Hospital Henri Mondor, Cardiology, Creteil, France
| | - G Barnabas
- Clinique ELSAN, Cardiology, Poitiers, France
| | - L Bonnefous
- University Hospital Henri Mondor, Public Health, Creteil, France
| | - F Beauvais
- Hospital Lariboisiere, Cardiology, Paris, France
| | - T Pezel
- Hospital Bichat-Claude Bernard, Cardiology, Paris, France
| | - F Bauer
- University Hospital of Rouen, Cardiology, Rouen, France
| | - O Raitiere
- University Hospital of Rouen, Cardiology, Rouen, France
| | - C Taieb
- European Market Maintenance Assessment (EMMA), Fontenay sous Bois, France
| | - V Benedyga
- University Hospital Henri Mondor, Dietetic, Creteil, France
| | - S Bastuji Garin
- University Hospital Henri Mondor, Public Health, Creteil, France
| | - J P David
- University Hospital Henri Mondor, Geriatric, Creteil, France
| | - E Audureau
- University Hospital Henri Mondor, Public Health, Creteil, France
| | - T Damy
- University Hospital Henri Mondor, Cardiology, Creteil, France
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Chemla D, Berthelot E, Weatherald J, Lau E, Attal P, Boulate D, Montani D, Jourdain P, Humbert M, Assayag P, Herve P. P4690Effects of pulmonary artery wedge pressure on right ventricular pulsatile loading in pulmonary hypertension: a reappraisal based on pulmonary arterial isobaric stiffness. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) is associated with stiffening of pulmonary arteries. Previous studies have suggested that high pulmonary artery wedge pressure (PAWP) in postcapillary PH (Pc-PH) further augments PA stiffness at a given level of pulmonary vascular resistance as compared to pulmonary arterial hypertension (PAH). However, these studies do not take into account differences in distending pressure (mean PA pressure, mPAP), which has an effect on stiffness due to non-linear stress-strain behavior of arteries.
Purpose
To compare total PA stiffness between Pc-PH and idiopathic PAH (iPAH) studied at similar mPAP (isobaric stiffness).
Methods
This was an analysis of right heart catheterization results obtained in 112 Pc-PH and 112 iPAH patients extracted from the French PAH network registry and matched for mPAP (median 38 vs 39 mmHg, P=NS), age (70.5 years each) and sex (64% female each). Total PA stiffness was calculated as the ratio of PA pulse pressure to indexed stroke volume.
Results
Total PA stiffness (n=224) increased with mPAP (Spearman's rho = 0.66) and decreased with PAWP (rho = - 0.17) (each P<0.01). The isobaric stiffness was lower in Pc-PH (median (IQR) = 0.91 (0.64–1.39) mmHg/mL/m2) than in iPAH (1.18 (0.83–1.62) mmHg/mL/m2, P<0.01). The patients were then stratified according to their mPAP (25–35 mmHg, n=74 (37/37); 36–43 mmHg, n=75 (34/41); and 44–66 mmHg, n=75 (41/34)). The isobaric stiffness was lower in Pc-PH than iPAH in the 1st mPAP tertile (0.62 vs 0.83 mmHg/mL/m2, P=0.06), in the 2nd mPAP tertile (0.76 vs 1.22 mmHg/mL/m2, P<0.01) and in the 3rd mPAP tertile (1.41 vs 1.77 mmHg/mL/m2, P<0.01). The pulmonary vascular resistance was lower in Pc-PH than iPAH in every mPAP tertile (each P<0.01). Finally, Pc-PH had a higher indexed stroke volume than iPAH (37 (29–48) vs 32 (27–40) mL/m2, P<0.01) while systolic PA pressure and PA pulse pressure were similar.
Conclusion
Unexpectedly, the isobaric pulmonary arterial stiffness was lower in Pc-PH than iPAH patients. It is proposed that PAWP attenuates the increase in RV pulsatile loading in PH when the natural high-strain-induced stiffening was accounted for. This may contribute to a less impaired right ventricular-PA coupling leading to higher indexed stroke volume in Pc-PH than iPAH despite similar PA pressure. At every mPAP level, both the lower PA stiffness and lower pulmonary vascular resistance in Pc-PH than in iPAH may contribute to explain differences in the pressure overload-induced right ventricular adaptation between the two diseased groups, a point that deserves to be confirmed by further studies.
Acknowledgement/Funding
University regular funds
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Affiliation(s)
- D Chemla
- Paris South Faculty of Medicine, Kremlin-Bicetre, France
| | - E Berthelot
- Paris South Faculty of Medicine, Kremlin-Bicetre, France
| | | | - E Lau
- Paris South Faculty of Medicine, Kremlin-Bicetre, France
| | - P Attal
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - D Boulate
- Surgical Centre Marie Lannelongue, Le Plessis Robinson, France
| | - D Montani
- Paris South Faculty of Medicine, Kremlin-Bicetre, France
| | - P Jourdain
- Paris South Faculty of Medicine, Kremlin-Bicetre, France
| | - M Humbert
- Paris South Faculty of Medicine, Kremlin-Bicetre, France
| | - P Assayag
- Paris South Faculty of Medicine, Kremlin-Bicetre, France
| | - P Herve
- Surgical Centre Marie Lannelongue, Le Plessis Robinson, France
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Bonnefous L, Bezard M, Bodez D, Berthelot E, Pezel T, Gauthier J, Beauvais F, Mansourati J, Koukoui F, Roubille F, Barigou A, Trochu J, Le Helloco A, Gibelin P, Chong-Nguyen C, Bauer F, Vergeylen U, Gellen B, Audureau E, Damy T. Cluster analysis of the 2822 patients with heart failure included in the Multicenter French Survey OFICSEL. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pezel T, Berthelot E, Gauthier J, Chong-Nguyen C, Iliou M, Juilliere Y, Galinier M, De Groote P, Lehelloco A, Bauer F, Vergeylen U, Gellen B, Raphael P, Bezard M, Ricci J, Boiteux M, Bonnefous L, Bodez D, Audureau E, Damy T. Characteristics of heart failure patients using a Smartphone in the OFICSel cohort to develop a futur specific numeric application. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pezel T, Berthelot E, Gauthier J, Chong-Nguyen C, Iliou M, Juilliere Y, Galinier M, De Groote P, Lehelloco A, Bauer F, Vergeylen U, Gellen B, Raphael P, Bezard M, Ricci J, Boiteux M, Bonnefous L, Bodez D, Audureau E, Damy T. Characteristic of diet regimen, education program, internet and smartphone usages in french heart failure patients to propose new therapeutic education tools.A report from OFICSel cohort. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bouvarel A, Bailly MT, Robard I, Dahan B, Andarelli J, Sitbon O, Assayag P, Berthelot E. What influences echocardiography reliability in estimation of pulmonary pressure? Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Berthelot E, Bailly MT, Andarelli J, Dahan B, Robard I, Assayag P. Left-ventricular filling pressure estimation in HFpEF, is echocardiography reliable? Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bailly MT, Berthelot E, Dahan B, Robard I, Andarelli JN, Assayag P. P3737Left ventricular filling pressure estimation in HFpEF, is echocardiography reliable? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M T Bailly
- AP-HP - Hospital Bicetre, University Paris Sud 11, Le Kremlin-Bicetre, France
| | - E Berthelot
- AP-HP - Hospital Lariboisiere, Department of Cardiology, Paris, France
| | - B Dahan
- AP-HP - Hospital Bicetre, University Paris Sud 11, Le Kremlin-Bicetre, France
| | - I Robard
- AP-HP - Hospital Bicetre, University Paris Sud 11, Le Kremlin-Bicetre, France
| | - J N Andarelli
- AP-HP - Hospital Bicetre, University Paris Sud 11, Le Kremlin-Bicetre, France
| | - P Assayag
- AP-HP - Hospital Bicetre, University Paris Sud 11, Le Kremlin-Bicetre, France
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Audureau E, Berthelot E, Taieb C, Beauvais F, Logeart D, Gellen B, Galinier M, Hemery T, Chong-Nguyen C, De Nadai N, Juilliere Y, Assyag P, Iliou M, Pezel T, De Groote P, Damy T. Prescription, adherence and burden related to sodium-restricted dietary inpatients with heart failure: Preliminary results from the French national OFICSel observatory. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Damy T, Isnard R, Salvat M, Tribouilloy C, Picard F, Eicher J, Roubille F, Trochu J, Roul G, De Groote P, Berthelot E, Naccache N, Bauer F, Logeart D. Prevalence and determinants of pulmonary arterial hypertension (PAH) in acute and chronic heart failure (CHF). FRESH study from GICC. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Berthelot E, Bailly M, Elhatimi S, Robard I, Montani D, Sitbon O, Chemla D, Assayag P. Hemodynamic correlates of right ventricular dilation in pulmonary hypertension due to HFpEF. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Berthelot E, Bailly M, El Hatimi S, Robard I, Montani D, Chemla D, Assayag P. P4362What influences right ventricle dilation in HFpEF? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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El Hatimi S, Hammoudi N, Barthelemy O, Choussat R, Collet J, Berthelot E, Bouchachi A, Assayag P, Leprince P, Lefeuvre C, Helft G. Impact of screening by coronary angiography and revascularization by angioplasty of significant coronary lesions before transcatheter aortic valve implantation. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berthelot E, El Hatimi S, Bailly M, Robard I, Sitbon O, Assayag P. Echographic characteristics of PH in HFpEF and precapillary PH. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30150-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gzara H, Berthelot E, Soyer P, Sirol M. Unusual endomyocardial fibrosis with apical calcification. Diagn Interv Imaging 2015; 96:1215-7. [PMID: 26066548 DOI: 10.1016/j.diii.2015.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/22/2015] [Indexed: 11/16/2022]
Affiliation(s)
- H Gzara
- Department of body and interventional imaging, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; Université Sorbonne Paris-Cité, Diderot Paris 7, 10, avenue de Verdun, 75010 Paris, France
| | - E Berthelot
- Department of body and interventional imaging, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; Université Sorbonne Paris-Cité, Diderot Paris 7, 10, avenue de Verdun, 75010 Paris, France
| | - P Soyer
- Department of body and interventional imaging, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; Université Sorbonne Paris-Cité, Diderot Paris 7, 10, avenue de Verdun, 75010 Paris, France
| | - M Sirol
- Department of body and interventional imaging, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; Université Sorbonne Paris-Cité, Diderot Paris 7, 10, avenue de Verdun, 75010 Paris, France.
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Berthelot E, Berthelot-Garcias E, Voicu S, de Menthon M, Logeart D, Mahr A, Nataf P, Fabre A, Sirol M, Cohen-Solal A. Unusual pseudotumoral right atrial involvement in Listeria monocytogenes septicemia. Circulation 2012; 126:e66-8. [PMID: 22869861 DOI: 10.1161/circulationaha.112.096347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E Berthelot
- Hôpital Lariboisière, Service de Cardiologie, 10, rue Ambroise Paré, 75010 Paris, France.
| | - E Berthelot-Garcias
- Hôpital Lariboisière, Service de Cardiologie, 10, rue Ambroise Paré, 75010 Paris, France.
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Callet N, Cohen-Solal Le Nir CC, Berthelot E, Pichon MF. Cancer of the uterine cervix: sensitivity and specificity of serum Cyfra 21.1 determinations. EUR J GYNAECOL ONCOL 1998; 19:50-6. [PMID: 9476060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose was to evaluate the usefulness of serum Cyfra 21.1 assay for the monitoring of patients with uterine cervix cancer. METHODS Pre-treatment sera and complete follow-up of the patients were available for SCC and Cyfra 21.1 for 79 patients Another group of 50 patients was studied to evaluate the specificity, sensitivity, negative or positive predictive values of the markers. The cut-off value for Cyfra 21.1 (1.1 ng/ml) was established by ROC curve analysis. RESULTS A positive or negative concordance between SCC and Cyfra 21.1 was observed in 65.8% of the cases. Positive SCC and negative Cyfra 21.1 were found in 22.8% of the sera, while the inverse was observed in 11.4% of the cases. The mean concentrations of SCC and Cyfra 21.1 were correlated to FIGO stages, with Cyfra 21.1 being elevated in 100% of stages III and IV. Cyfra 21.1 was also correlated with the extension of the cancer, and to the presence of metastases. The mean concentrations of both markers were significantly higher in the sera of patients with constant progression (P < or = 0.0019). Analysis of 186 results from 91 patients followed-up with a median of 3.29 years showed a sensitivity of 89.5% for Cyfra 21.1, 75.0% for SCC, and a specificity of 86.4% and 99.1%, respectively. The positive predictive values were 91.9% for Cyfra 21.1 and 98.3% for SCC, and the negative predictive values 92.7% and 85.2%, respectively. Median lead times, calculated from the records of 18 selected patients with complete resection of the tumour, were found to be 60 days for Cyfra 21.1 and 50 days for SCC (P > 0.05). CONCLUSION In cervical cancer Cyfra 21.1 is very well-correlated to the tumour burden and the extent of the disease. In the case of recurrence, this marker rises more often than SCC. We therefore propose the use of Cyfra 21.1 for the monitoring of cervical cancer.
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Affiliation(s)
- N Callet
- Service de Gynécologie, Centre René Huguenin, Saint-Cloud, France
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